Correlation between the Distribution of Contrast Medium and the Extent of Blockade during Epidural Anesthesia

2004 ◽  
Vol 100 (6) ◽  
pp. 1504-1510 ◽  
Author(s):  
Masataka Yokoyama ◽  
Motohiko Hanazaki ◽  
Hiromi Fujii ◽  
Satoshi Mizobuchi ◽  
Hideki Nakatsuka ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Individual Variation ◽  
Catheter Position ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Analgesic Block ◽  
Position Group

Background If the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread. Methods An epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded. The analgesic area was determined by pinprick after a 5-ml injection of 1.5% lidocaine, and epidurography was performed after a 5-ml injection of 240 mg I/ml iotrolan. Patients were assigned to three groups according to catheter tip position (group C: C-T4; group T: T5-T10; group L: T11-L), and patterns of spread were compared. In 16 of 90 subjects, radiographic and analgesic spread was further investigated after an additional 5-ml injection of iotrolan and lidocaine. Results The total radiographic spread correlated well with analgesic spread (right side: Y = 0.84 X + 0.16, r = 0.92, P < 0.01; left side: Y = 0.78 X + 0.45, r = 0.91, P < 0.01). The mean radiographic spread in the cephalad and caudal directions from the catheter tip also correlated well with mean analgesic spread (r = 0.97, P < 0.01, each direction). The mean distance between the predicted catheter tip and radiographically determined positions was 1.0 +/- 0.8 segments: the value in group T was significantly larger than that in groups C (P < 0.05) and L (P < 0.01). Although the correlation of radiographic spread with age was statistically significantly (r = 0.39, P < 0.01), great individual variation in spreading pattern was seen. In 16 subjects, mean radiographic spread correlated well with analgesic spread after 5- and 10-ml injections of iotrolan and lidocaine. Conclusions Epidurography is useful to indicate epidural catheter position and can help to predict the exact dermatomal distribution of analgesic block.

scholarly journals Evaluation of epidural catheter tip position

2003 ◽  
Vol 50 (9) ◽  
pp. 963-963
Author(s):  
René Martin ◽  
Martine Pirlet ◽  
Michel Parent ◽  
France Gingras
Keyword(s):  
Epidural Catheter ◽  
Catheter Tip ◽  
Tip Position

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

2020 ◽  
Vol 21 (5) ◽  
pp. 732-737
Author(s):  
Chunli Liu ◽  
Dingbiao Jiang ◽  
Tao Jin ◽  
Chuanyin Chen ◽  
Ruchun Shi ◽  
...  
Keyword(s):  
Upright Position ◽  
Body Posture ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Posture Change ◽  
Body Change ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Chinese Cancer Patients

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients. Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement. Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was –15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p = 0.009) and height ( p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change. Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Intra- and Inter-Rater Agreement between X-Ray Views for Umbilical Catheter Position

2019 ◽  
Author(s):  
Srinivasa Murthy Doreswamy ◽  
Sumesh Thomas ◽  
Sourabh Dutta
Keyword(s):  
Random Sequence ◽  
Venous Catheter ◽  
Rater Agreement ◽  
Catheter Position ◽  
X Ray ◽  
Umbilical Catheter ◽  
Catheter Tip ◽  
Tip Position ◽  
Umbilical Arterial Catheter

Abstract Objective We determined intra- and inter-rater agreement for umbilical arterial/venous catheter (umbilical arterial catheter [UAC] and umbilical venous catheter [UVC], respectively) positions on supine anteroposterior (AP) and horizontal dorsal decubitus (HDD) X-ray views to determine whether two views are routinely required. Study Design This retrospective study was conducted in McMaster University, Canada. Pairs of AP and HDD radiographs were coded and rated in random sequence by two experienced raters. Primary outcome was intra-rater agreement (κ) between AP and HDD views for UVC catheter tip position. Secondary outcomes included inter-rater κ for UVC position; inter- and intra-rater κ for UAC position, inter- and intra-rater κ for follow-up action. To detect κ of 0.8 (width of 95% confidence interval = 0.1), 138 radiograph pairs were required. Results Intra-rater agreement tended to be higher for UVC versus UAC position (Rater#1: κ = 0.44 vs. 0.16, respectively, p = 0.08; and #2: κ = 0.56 vs. 0.47, respectively, p = 0.5). Inter-rater agreement was higher on AP versus HDD view for UVC position (κ = 0.6 vs. 0.29, respectively, p = 0.03) and action recommended for UVC (κ = 0.61 and 0.19, respectively, p < 0.001). Conclusion AP is superior to HDD view for UVC.

scholarly journals Management of a ruptured epidural catheter, an anesthesiologist's dilemma: a case report

2020 ◽  
Vol 9 (1) ◽  
pp. 282
Author(s):  
Rodrigo A. Mendoza-Aceves ◽  
Rodrigo Banegas-Ruiz ◽  
Francisco F. Gómez-Mendoza ◽  
Rigoberto R. Román-Hernández ◽  
Jesica A. Aguirre-Ramírez ◽  
...  
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Diabetic Foot ◽  
Epidural Block ◽  
Anesthetic Technique ◽  
Safe Procedure ◽  
Catheter Tip ◽  
Broken Needle

Epidural anesthesia is a widely used anesthetic technique in lower extremity surgeries although it is a relatively safe procedure, it can have complications, such as rupture of the epidural catheter. This is a 69-year-old male patient with a diagnosis of Wagner IV diabetic foot is presented, which was scheduled for left supracondylar amputation in which after epidural block, retention of the catheter tip in the epidural space at level L2-L3 was seen, so hemi laminectomy was performed in a second surgical stage in L2 and removal of the epidural catheter. Ideally a broken needle should be removed as soon as possible.

scholarly journals 38 Does Umbilical Venous Catheter tip position impact complication rates in neonates?

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e15-e15
Author(s):  
Sunil Joghee
Keyword(s):  
Cardiac Arrhythmias ◽  
Venous Catheter ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Optimal Position ◽  
High Position ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Late Insertion

Abstract Background Umbilical venous catheter (UVC) insertion is a very common procedure in neonatal intensive care units (NICU). UVCs are placed in ideal position in only about 50% cases. It is common practice to secure UVC in low position in the event of failure to place in optimal position. However, little is known about the association between catheter tip position and UVC related complications in neonates. Objectives The primary objective was to examine the association between the UVC tip position and UVC related complications in neonates. Our secondary objective was to evaluate the association between timing of UVC insertion and complication rates. Design/Methods We performed a retrospective cohort study of all neonates who had UVC inserted in a tertiary NICU between January 2017 and December 2018. Neonates with major congenital or chromosomal anomalies, hydrops fetalis and prenatally diagnosed cardiac arrhythmias or pericardial effusion were excluded. Electronic medical records and medical charts were reviewed. The primary outcome was presence of any one of the following complications: cardiac (arrhythmias, pericardial effusion, intracardiac thrombosis), hepatic (liver hematoma, cystic fluid collection in the liver, liver abscess, portal vein thrombosis), catheter associated infection, and mechanical complications. We compared the complications rates based on UVC tip position as determined by thoraco-abdominal radiograph. Optimal UVC position was defined as catheter tip between T8-T10 vertebral levels; low position as below T10 and high position as above T8. We also examined the association between time at UVC insertion (i.e. early (&lt;12 hours) versus late (≥12 hours) and the type of complications. Results Among the 589 neonates who had UVC inserted during the study period, 40 were excluded. Of 549 included, UVC tip was at optimal position in 267 (48.6%), low position in 248 (45.2%) and high position in 34 (6.2%) neonates. The mean gestational age and birth weight of the study cohort were 30.9 ± 5.1 weeks and 1712 ± 1035g respectively. The mean birth weight and gestational age were comparable among the three groups. The overall complication rate was 36/549 (6.5%). There were no significant differences in the overall complication rates between the three groups (Table 1). However, cardiac complications (arrhythmias) were more frequent in the high UVC group compared to the optimum position group (8.8% vs 0.37%, OR 10; 95% CI 1.84, 56.5). Among 549 neonates, 391 had early UVC insertion and 158 had late insertion of UVC. There was no significant difference in UVC related complications between early and late insertion of UVC (6.9 % versus 5.7%, OR 2.49; 95% CI 0.34, 17.8). Conclusion The UVC related complications were more frequent in infants with high UVC position and least among those with optimal UVC position; although not statistically significant, it may be clinically important. High UVC position was more frequently associated with cardiac complications. There was no difference in complication rates between early and late UVC insertion.

Influence of Catheter Tip Position on Pulmonary Wedge Pressures

1962 ◽  
Vol 10 (2) ◽  
pp. 215-219 ◽  
Author(s):  
A. L. Loomis Bell ◽  
William F. Haynes ◽  
Seiichi Shimomura ◽  
Donald P. Dallas
Keyword(s):  
Catheter Tip ◽  
Tip Position

Peroperative intravasal electrographic control of catheter tip position in access ports placed by venous cut-down technique

2001 ◽  
Vol 27 (3) ◽  
pp. 316-320 ◽  
Author(s):  
M. Stas ◽  
S. Mulier ◽  
P. Pattyn ◽  
J. Vijgen ◽  
I. De Wever
Keyword(s):  
Catheter Tip ◽  
Tip Position

Precision in Central Venous Catheter Tip Placement: A Review of the Literature

2010 ◽  
Vol 15 (3) ◽  
pp. 112-125 ◽  
Author(s):  
Russell Hostetter ◽  
Nadine Nakasawa ◽  
Kim Tompkins ◽  
Bradley Hill
Keyword(s):  
Central Venous Catheter ◽  
Selection Criteria ◽  
Weighted Average ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Landmark Technique ◽  
The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

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